Community-acquired enterococcal urinary tract infections in hospitalized children

Abstract

The objectives of this study were to characterize community-acquired (CA) enterococcal urinary tract infections (UTIs) in a tertiary pediatric center and to determine risk factors for their occurrence, their association with renal abnormalities, their antibiotic susceptibility profile, and the appropriateness of the empiric antibiotic treatment, in comparison to those of Gram-negative UTIs. In a 5-year prospective clinical and laboratory study, we found that enterococcal UTIs caused 6.2% (22/355) of culture-proven CA UTIs. Compared with Gram-negative UTI, enterococcal UTI was associated with male predominance, higher rates of underlying urinary abnormalities (70 vs. 43.7%; p = 0.03) and inappropriate empiric antibiotic therapy (22 vs. 5.6%; p = 0.02), and mainly vesicoureteral reflux (53% of cases). This study highlights the importance of early detection of CA enterococcal UTIs because of their association with underlying urinary abnormalities and a high rate of inappropriate empiric antibiotic therapy. Renal imaging is recommended for children with enterococcal UTIs; Gram stain is suggested in selected cases to detect Gram-positive cocci for early diagnosis of enterococcal UTIs and initiation of appropriate antibiotics.

Comparison of Febrile Infants With Enterococcal and Gram-negative Urinary Tract Infections

“…[8][9][10] The abnormal urinary tract may make it possible for less virulent bacteria, such as enterococcus species, to cause infections. 14 Though enterococcus species are not as inherently virulent as uropathogenic E. coli, they do possess virulence factors such as enterococcal surface protein (Esp) that enables the bacteria to cause UTIs by adhering to medical devices.…”

“…Given the prior potential association between enterococcal UTIs and genitourinary abnormalities, specifically VUR, [8][9][10] we conducted a multivariable logistic regression analysis to assess whether hydronephrosis and VUR ≥ grade 3, determined by studies performed after UTI diagnosis, were independently associated with enterococcal UTIs. We included variables in the model that had potential association on bivariable analysis (p <0.05)…”

“…There also appears to be a higher prevalence of enterococcal UTIs in children with underlying genitourinary abnormalities, specifically vesicoureteral reflux (VUR). [8][9][10] There are limited data, however, regarding community-acquired enterococcal UTIs in infants. In a previous study of febrile infants with UTIs who presented to the emergency department (ED), we noted that these patients typically had benign clinical courses if they did not have high-risk past medical histories and were well appearing in the ED.…”

“…[1][2][3][4] Most UTIs in infants and young children are caused by Gram-negative bacilli such as Escherichia coli, which accounts for 80-90% of infections. [4][5][6][7] Of the Gram-positive uropathogens, Enterococcus faecalis is the predominant species and accounts for approximately 4-6% of UTIs in infants and children, [8][9][10] and is a common source of nosocomial UTIs. 11,12 Enterococcus readily acquires resistance to a number of antibiotics, enabling it to thrive in the hospital setting.…”

Update on recent guidelines for the management of urinary tract infections in children

“…The prevalence of E. coli isolates resistant to ampicillin was 50%. Marcus et al [26] reviewed the UTI pathogens and their antibiotic susceptibility in Schneider Children’s Medical Center of Israel from 2001 to 2005. Of the 355 culture-proven UTI episodes, 26 (6.2%) were due to Enterococcus spp., and the remaining 333 (93.8%) to Gram-negative bacteria, mainly E. coli, Klebsiella spp., and Pseudomonas aeruginosa .…”